Real time adaptive controller medication dosing

ABSTRACT

Systems and methods for monitoring accurate, real-time medicament device events, performing analytics on that data, and providing notifications are described. In various embodiments, an application server receives controller medication events, analyzes the events, associated event times, and controller medication dosage plans to characterize event times and send notifications for future doses. The controller medication dosage plan may specify a dose time for a planned dose, a narrow time window comprising the dose time, and an expanded time window comprising the narrow time window and longer in duration than the narrow time window, and the events may be characterized based on their time relative to the dose time, the time windows, and other events.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.16/292,303 filed on Mar. 4, 2019, which is a continuation of U.S. patentapplication Ser. No. 15/351,197 filed on Nov. 14, 2016, which claims thebenefit of U.S. Provisional Application No. 62/255,213, filed on Nov.13, 2015, all of which are incorporated by reference herein in theirentirety for all purposes.

BACKGROUND Field of Art

The disclosure relates generally to medicament device usage, and morespecifically to device usage, analyzing adherence with respect tomedicament treatment plans, and providing information to patients andother parties based on that analysis.

Description of the Related Art

Asthma remains a significant and costly public health problem. In theUnited States, more than 22 million people have the disease. Worldwide,the World Health Organization estimates the population with asthma maybe 300 million, and predicts that it will rise to 400 million by 2025.

Despite the development of new medications, rates of hospitalizationsand emergency room visits have not declined. Each year in the UnitedStates the disease causes approximately 2 million emergency departmentvisits, 500,000 hospitalizations, and 5,000 deaths. In addition, asthmais responsible for an estimated 15 million missed days of school, and 12million days of work. Total annual costs to US health insurers andemployers are greater than $18 billion.

The majority of these exacerbations could be prevented with currentlyavailable treatments, however, only 1 in 5 asthmatics has the diseaseunder control. Newly revised national guidelines urge doctors to moreclosely monitor whether treatment is controlling everyday symptoms andimproving quality of life. Physicians, however, have few available toolsto assess how well their patients are doing day-to-day. An increasingnumber of physicians have begun to use periodic, written questionnaires(such as the Asthma Control Test) to monitor patients and determinetheir level of control. These instruments require patients to accuratelyrecall and report the frequency of symptoms, inhaler usage, and activitylevel and restriction over some period of time (usually two to fourweeks). As a result, these questionnaires are subject to errorintroduced by biases (recall), different interpretations of symptoms,and behaviors (non-adherence), and only provide information at the timethey are used.

SUMMARY

An adherence analytics system is a unified platform for monitoringaccurate, real-time medicament device usage, performing analytics onthat data, and providing notifications according to the analytics. Theadherence analytics system receives respiratory medication events byreceiving notifications from a sensor attached to a medicament device(e.g. inhaler) used by a patient who has authorized the analytics systemto help manage their respiratory disease (e.g., asthma, COPD, etc.). Thesensor, when attached to or incorporated in a metered dose inhaler orother medicament device, records the geographical location, time, anddate where and when a rescue or controller medication event takes place,and communicates that information to the analytics system. The analyticssystem analyzes the received events (both the most recent and previouslyreceived events) in real time or near-real time, and delivers timelyinformation on the use of inhaled medications to inform and guidemanagement of the disease, including alerts to patients and thehealthcare providers and information regarding a patient's adherence toa medication plan. The information may include instructions to take ornot take a planned dose, periodic summaries of adherence, and othermessages to encourage better adherence behavior. By providinginformation regarding a patient's adherence to a medication plan, theanalytics system can assist patients in better managing respiratorydiseases.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 shows an analytics system for monitoring accurate, real-timemedicament device usage, performing analytics on that data, andproviding notifications according to the analytics, according to oneembodiment.

FIG. 2 is a high-level block diagram illustrating an example of acomputing device used in either as a client device, application server,and/or database server, according to one embodiment.

FIG. 3A shows a dashboard of a client application that allows a user tointeract with an analytics system, according to one embodiment.

FIGS. 3B-3N illustrate example cards displayed within the dashboard ofthe client application, according to one embodiment.

FIG. 4 shows a flowchart for detecting a medication event by ananalytics system, according to one embodiment.

FIG. 5A illustrates a first embodiment for determining whether torecommend that the patient take their next dose, as may be included in anotification sent to the patient's device.

FIG. 5B illustrates an example of the timeline of the first embodimentfor a dosing plan that specifies that a dose is to be taken four times aday.

FIGS. 5C-5G illustrate additional examples of timelines of the firstembodiment for a dosing plan that specifies that a dose is to be takentwice a day.

FIG. 5H-5L illustrate example display cards that may be presented aspart of notifications in accordance with this first embodiment.

FIG. 6A illustrates a second embodiment for determining whether torecommend that the patient take their next dose, as may be included in anotification sent to the patient's device.

FIG. 6B illustrates an example of the timeline of the second embodimentfor a dosing plan that specifies that a dose is to be taken two times aday.

FIGS. 6C-6G illustrate additional examples of timelines of the firstembodiment for a dosing plan that specifies that a dose is to be takentwice a day.

FIGS. 6H and 6I illustrate example display cards that may be presentedas part of notifications in accordance with this first embodiment.

DETAILED DESCRIPTION I. System Environment

FIG. 1 shows an analytics system 100 for monitoring accurate, real-timemedicament device events, performing analytics on that data, andproviding notifications, according to one embodiment.

The analytics system includes client computing devices 110, a medicamentdevice sensor 120, a medicament device 160, an application server 130,database server 140, and a network 150. Although FIG. 1 illustrates onlya single instance of most of the components of the analytics system 100,in practice more than one of each component may be present, andadditional or fewer components may be used.

I.A. Client Device and Application

The client devices 110, at the behest of their users, interact with theanalytics system 100 via the network 150. For purposes of explanationand clarity it is useful to identify at least two different types ofusers. A patient 111 is a user burdened with respiratory impairment whomakes use of the analytics system 100 at least in part to obtainpersonalized notifications provided by the server 130 and by theirhealth care provider 112. Such notifications can be provided in exchangefor the user's permission to allow the analytics system 100 to monitorthe patient's 111 medicament device 160 usage. As will be explainedbelow, medication events are detected by a sensor 120 associated withthe medicament device 160 and the user's client device 100, which inturn reports to the application server 130, which in turn can initiate aprocess to generate risk notifications which are provided to the userthrough the client device 110.

Another type of user is a healthcare provider 112 who, again with thepatient's 111 express permission, also receives notifications regardinga patient's management, as well as aggregated rescue or controllermedication event data and derived statistics based on these events andother associated data. Other types of users are also contemplated, suchas parents/guardians of patients 111 who may also with to receivenotifications in the event that their own client devices 110 aredistinct from that of their children.

The client device 110 is a computer system, an example physicalimplementation which is described more completely with respect to FIG.2, below. The client device 110 is configured to wirelessly communicatewith the analytics system 100 via network 150. With network 150 access,the client device 110 transmits to system 100 the user's geographicallocation and the time of a controller or rescue medication event, aswell as information describing the event as received from the associatedmedicament device sensor 120 (referred to throughout as “sensor 120”).

Regarding user location and event times, the client device 110 maydetermine the geographical location and time of a rescue event throughuse of information about the cellular or wireless network 150 to whichit is connected. For example, the current geographical location of theclient device 110 may be determined by directly querying the softwarestack providing the network 150 connection. Alternatively, thegeographical location information may be obtained by pinging an externalweb service (not shown in FIG. 1) made accessible via network 150. Thetime of an event can be provided by the sensor 120 as part of the eventdata or added to event data by querying an appropriate software routineavailable as part of the client device's native operating system.

In addition to communicating with the application server 130, clientdevices 110 connected wirelessly to the analytics system 100 may alsoexchange information with other connected client devices 110. Forexample, through a client software application 115, a healthcareprovider 112 may receive a risk exacerbation notification describing arecent rescue event about a patient 111, then in response send arecommendation to the patient 111 for post-chronic obstructive pulmonarydisease (COPD) exacerbation treatment. Similarly, through application115 patients 111 may communicate with their health care providers 112other patients 111.

Application 115 provides a user interface (herein referred to as a“dashboard”) that is displayed on a screen of the client device 110 andallows a user to input commands to control the operation of theapplication 115. The dashboard is the mechanism by which healthcareproviders 112 and patients 111 access the analytics system 100. Forexample, the dashboard allows patients 111 and providers 112 to interactwith each other, receive notifications, exchange messages abouttreatment, provide and receive additional event and non-event data, andso on. Application 115 may be coded as a web page, series of web pages,or content otherwise coded to render within an internet browser.Application 115 may also be coded as a proprietary applicationconfigured to operate on the native operating system of the clientdevice 110. The dashboard is more completely described below inconjunction with FIG. 3.

In addition to providing the dashboard, application 115 may also performsome data processing on rescue and controller medication event datalocally using the resources of client device 110 before sending theprocessed data through the network 150. Event data sent through thenetwork 110 is received by the application server 130 where it isanalyzed and processed for storage and retrieval in conjunction withdatabase server 140. The application server 130 may direct retrieval andstorage request to the database system 130 as required by the clientapplication 115.

The client device 110 communicates with the sensor 120 using a networkadapter and either a wired or wireless communication protocol, anexample of which is the BLUETOOTH Low Energy (BTLE) protocol. BTLE is ashort-ranged, low-powered, protocol standard that transmits datawirelessly over radio links in short range wireless networks. After thesensor 120 and client device 110 have been paired with each other usinga BTLE passkey, the sensor 120 automatically synchronizes andcommunicate information relating to medicament device usage with theclient device 110. If the sensor 120 hasn't been paired with a clientdevice 110 prior to a rescue medication event, the information is storedlocally until such a pairing occurs. Upon pairing, the sensor 120communicates any stored event records to the client device 110. In otherimplementations, other types of wireless connections, e.g., infrared or802.11.

Although client devices 110 and medicament devices 160 are describedabove as being separate physical devices (such as smart phones andinhalers, respectively), in the future it is contemplated the medicamentdevices 160 may include not only sensors 120 integrated into a singlehousing with the device 160, but also aspects of the client device 110.For example, a medicament device 160 may include an audiovisualinterface including a display or other lighting elements as well asspeakers for presenting visual audible information. In such animplementation the medicament device 160 itself may present the contentsof notifications provided by the server 130 directly, in place of or inaddition to presenting them through the client devices 110.

I.B. Medicament Device and Sensor

The medicament device 160 is a medical device used to deliver medicationto the lungs of a user experiencing constricted respiratory airflow.Medicament devices (e.g. inhalers) are typically portable and smallenough to be carried by hand for ease of accessibility when treatingrespiratory attacks. In one embodiment, medicine is delivered in aerosolform through a medicament device 160 such as a metered dose inhaler.Metered dose inhalers included a pressured propellant canister ofaerosol medicine, a metering valve for delivering a regulated medicinedosage amount, and a plastic holder that holds the pressurized canisterand also forms a mouthpiece for delivery of the medicine. In anotherembodiment, medicine is delivered in dry powder form through amedicament device 160 such as a dry powder inhaler. Dry powder inhalersmay have Cartesian ovular shaped bodies that house wheel and gearmechanisms enabling a user to index through a strip of dry powdermedication. The bodies of dry powder inhalers also include a manifoldand a mouthpiece to deliver dry powder to the user. Examples ofcontroller medications that are dispensed by a controller medicamentdevice 160 include beclomethasone, budesonide, and fluticasone as wellas combinations of those medications with a long-acting bronchodilatorsuch as salmeterol or formoterol. Examples of rescue medications thatare dispensed by a rescue medicament device 160 include albuterol,salbutamol, levalbuterol, metaproterenol, and terbutaline.

Each patient may be associated with more than one medicament device 160.For example, the patient may have a rescue medicament device 160 thatdispenses rescue medication, and a controller medicament device 160 thatdispenses controller medication. Similarly, each patient may beassociated with more than one sensor 120, each chosen to operate withone of the patient's medicament devices 160.

Generally, a sensor 120 is a physical device that monitors the usage ofthe medicament dispenser 160. The sensor 120 is either removablyattachable to the medicament dispenser without impeding the operation ofthe medication dispenser, or the sensor 120 is an integrated componentthat is a native part of the medicament dispenser 160 as made availableby its manufacturer.

The sensor 120 includes its own network adapter (not shown) thatcommunicates with the client device 110 either through a wiredconnection, or more typically through a wireless radio frequencyconnection. In one embodiment, the network adapter is a BLUETOOTH LowEnergy (BTLE) wireless transmitter, however in other embodiments othertypes of wireless communication may be used (e.g., infrared, 802.11).

The sensor 120 may also be configured to communicate more directly withthe application server 130. For example, if the network adapter of thesensor 120 is configured to communicate via a wireless standard such as802.11 or LTE, the adapter may exchange data with a wireless accesspoint such as a wireless router, which may in turn communicate with theapplication server 130 without necessarily involving the client device110 in every exchange of data. These two methods of communicating arenot mutually exclusive, and the sensor 120 may be configured tocommunicate with both the client device 110 and the application server130, for example using redundant transmission to ensure event dataarrives at the application server 130 or to provide information directlyto the client device 110 while the application server 130 is determiningwhat notification to provide in response to an event.

As introduced above, the sensor 120 captures data about usage of themedicament device 160. Specifically, each sensor 120 captures the timeand geographical location of either controller or rescue medicationevent, that is, usages of either the controller or rescue medicamentdevice 160, respectively, by the patient 111. Each sensor 120 transmitsthe event data in real-time or as soon as a network connection isachieved, automatically without input from the patient 111 or healthcare provider 112. The medication event information is sent to theapplication server 130 for use in analysis, generation of notifications,and aggregate analyses of event data across multiple patients.

To accomplish this goal, there are a number of different ways for thesensor 120 to be constructed, and in part the construction will dependupon the construction of the medicament device itself 160. Generally,all sensors 120 will include an onboard processor, persistent memory,and the network adapter mentioned above that together function torecord, store, and report medication event information to the clientdevice 110 and/or server 130. Sensors 120 may also include a clock forrecording the time and date of events.

Regarding specific sensor 120 constructions, traditional inhalers, suchas mechanical dose counters, are not designed with sensors 120 in mind,and thus the sensor 120 may be constructed accordingly. Someimplementations in this manner include mechanical, electrical, oroptical sensors to detect movement of the device 160, priming of thedevice, activation of the device, inhalation by the user, etc. Incontrast, modern inhalers, such as deflectable membrane dose counters,include electrical circuitry may report event information as anelectrical data signal which a sensor 120 is designed to receive andinterpret, for example the medicament device 160 itself may reportmovement, priming, and activation to the sensor 120.

More information regarding hardware and software components for thesensors 120 and medicament devices 160, as well as the interactionbetween them to record one or both of controller and rescue medicationevents can be found in U.S. patent application Ser. No. 12/348,424,filed Jan. 1, 2009, and International Application No. PCT/US2014/039014,filed May 21, 2014, both of which are incorporated by reference hereinin their entirety.

I.C. Application Server

The application server 130 is a computer or network of computers.Although a simplified example is illustrated in FIG. 2, typically theapplication server will be a server class system that uses powerfulprocessors, large memory, and faster network components compared to atypical computing system used, for example, as a client device 110. Theserver typically has large secondary storage, for example, using a RAID(redundant array of independent disks) array and/or by establishing arelationship with an independent content delivery network (CDN)contracted to store, exchange and transmit data such as thenotifications contemplated above. Additionally, the computing systemincludes an operating system, for example, a UNIX operating system,LINUX operating system, or a WINDOWS operating system. The operatingsystem manages the hardware and software resources of the applicationserver 130 and also provides various services, for example, processmanagement, input/output of data, management of peripheral devices, andso on. The operating system provides various functions for managingfiles stored on a device, for example, creating a new file, moving orcopying files, transferring files to a remote system, and so on.

The application server 130 includes a software architecture forsupporting access and use of the analytics system 100 by many differentclient devices 110 through network 150, and thus at a high level can begenerally characterized as a cloud-based system. The application server130 generally provides a platform for patients 111 and healthcareproviders 112 to report data recorded by the sensors associated withtheir medicament devices 160 including both rescue medication andcontroller medication events, collaborate on treatment plans, browse andobtain information relating to their condition and geographic location,and make use of a variety of other functions.

Generally, the application server 130 is designed to handle a widevariety of data. The application server 130 includes logical routinesthat perform a variety of functions including checking the validity ofthe incoming data, parsing and formatting the data if necessary, passingthe processed data to a database server 140 for storage, and confirmingthat the database server 140 has been updated.

The application server 130 stores and manages data at least in part on apatient by patient basis. Towards this end, the application server 130creates a patient profile for each user. The patient profile is a set ofdata that characterizes a patient 111 of the analytics system 100. Thepatient profile may include identify information about the patient suchas age, gender, current rescue medication, current controllermedication, notification preferences, a controller medication adherenceplan, and a list of non-patient users authorized to access to thepatient profile. The profile may further specify a device identifier,such as a unique media access control (MAC) address identifying the oneor more client devices 110 or sensors 120 authorized to submit data(such as controller and rescue medication events) for the patient.

The profile may specify which different types of notifications areprovided to patients 111 themselves and their personal healthcareproviders 112, as well as the frequency with which notifications areprovided. The patient may also authorize their healthcare provider begiven access to their patient profile and rescue event history. If thehealthcare provider is provided access to the patient profile of thepatient, the healthcare provider may specify controller adherence orrescue medication plans. Medication plans may include a prescribednumber of doses per day for controller medications.

The application server 130 also creates profiles for health careproviders 112. A health care provider profile may include identifyinginformation about the health care provider, such as the office location,qualifications and certifications, and so on. The health care providerprofile also includes information about their patient population. Theprovider profile may include access to all of the profiles of thatprovider's patients, as well as derived data from those profiles such asaggregate demographic information, rescue and controller medicationevent patterns, and so on. This data may be further subdivided accordingto any type of data stored in the patient profiles, such as bygeographic area (e.g., neighborhood, city) over by time period (e.g.,weekly, monthly, yearly).

The application server 130 receives rescue medication event informationfrom the client device 110 or the sensor 120, triggering a variety ofroutines on the application server 130. For example, a risk analysis maybe performed on rescue and controller medication use for multiplepatients to identify based on spatial/temporal clusters (or outbreaks)of medication use based on historically significant permutations fromindividual, geographic, clinical, epidemiologic, demographic, or spatialor temporal baselines or predicted or expected values. Other types ofanalyses include daily/weekly adherence trends, adherence changes overtime, adherence comparisons to other relevant populations (e.g., allpatients, patients on a particular rescue medication or controllermedication or combination thereof, identification of triggers (spatial,temporal, environmental), rescue use trends over time, and rescue usecomparisons to other relevant populations.

Responsive to any analyses performed, the application server 130prepares and delivers push notifications to send to patients 111,authorized healthcare providers 112, and/or other users provided accessto the patient's profile. Notifications can provide details about thetiming, location, and affected patient(s) 111 involved in a medicationrescue event. Notifications may additionally comprise a distress oremergency signal that requests emergency assistance that are distributedto emergency assistance providers 112.

In addition to providing push notifications, the server 130 may alsoprovide pull notifications, for example at particular time intervals.Additionally, some notifications (regardless of type) may be triggerednot in response to a particular event that has occurred to the patient,but in response to one of the underlying factors of an analysisperformed by the server 130 changing. For example, if weather conditionsindicate that an increase in air pollution is occurring or is imminent,this may trigger the carrying out of COPD risk analyses for all patientslocated in the particular geographic area where the pollution isoccurring.

Notifications are provided through the network 150 to clientapplications 115 in a data format specifically designed for use with theclient applications, and additionally or alternatively may be providedas short message service (SMS) messages, emails, phone calls, or inother data formats communicated using other communication mediums.

I.D. Database Server

The database server 140 stores data patient and provider data relateddata such as profiles, medication events, patient medical history (e.g.,electronic medical records). Patient and provider data is encrypted forsecurity and is at least password protected and otherwise secured tomeet all Health Insurance Portability and Accountability Act (HIPAA)requirements. Any analyses that incorporate data from multiple patients(e.g., aggregate rescue medication event data) and are provided to usersis de-identified so that personally identifying information is removedto protect patient privacy.

The database server 140 also stores non-patient data used in analyses.This data includes regional data about a number of geographic regionssuch as public spaces in residential or commercial zones where patientsare physically located and may be exposed to pollutants. This data mayspecifically include or be processed to obtain a patient's proximity togreen space (areas including concentrated numbers of trees and plants)and proximity to different types of human organizations such as may beused to infer a patient's socioeconomic status. One example of regionaldata includes georeferenced weather data, such as temperature, windpatterns, humidity, the air quality index, and so on. Another example isgeoreferenced pollution data, including particulate counts for variouspollutants at an instance of time or measured empirically. The regionaldata includes information about the current weather conditions for thetime and place of the rescue event such as temperature, humidity, airquality index. All of the items of data above may vary over time, and assuch the data itself may be indexed by time, for example separate datapoints may be available by time of day (including by minute or hour), orover longer periods such as by day, week, month, or season.

Although the database server 140 is illustrated in FIG. 1 as being anentity separate from the application server 130 the database server 140may alternatively be a hardware component that is part of another serversuch as server 130, such that the database server 140 is implemented asone or more persistent storage devices, with the software applicationlayer for interfacing with the stored data in the database is a part ofthat other server 130.

The database server 140 stores data according to defined databaseschemas. Typically, data storage schemas across different data sourcesvary significantly even when storing the same type of data includingcloud application event logs and log metrics, due to implementationdifferences in the underlying database structure. The database server140 may also store different types of data such as structured data,unstructured data, or semi-structured data. Data in the database server140 may be associated with users, groups of users, and/or entities. Thedatabase server 140 provides support for database queries in a querylanguage (e.g., SQL for relational databases, JSON NoSQL databases,etc.) for specifying instructions to manage database objects representedby the database server 140, read information from the database server140, or write to the database server 140.

I.E. Network

The network 150 represents the various wired and wireless communicationpathways between the client 110 devices, the sensor 120, the applicationserver 130, and the database server 140. Network 150 uses standardInternet communications technologies and/or protocols. Thus, the network150 can include links using technologies such as Ethernet, IEEE 802.11,integrated services digital network (ISDN), asynchronous transfer mode(ATM), etc. Similarly, the networking protocols used on the network 150can include the transmission control protocol/Internet protocol(TCP/IP), the hypertext transport protocol (HTTP), the simple mailtransfer protocol (SMTP), the file transfer protocol (FTP), etc. Thedata exchanged over the network 150 can be represented usingtechnologies and/or formats including the hypertext markup language(HTML), the extensible markup language (XML), etc. In addition, all orsome links can be encrypted using conventional encryption technologiessuch as the secure sockets layer (SSL), Secure HTTP (HTTPS) and/orvirtual private networks (VPNs). In another embodiment, the entities canuse custom and/or dedicated data communications technologies instead of,or in addition to, the ones described above.

II. Example Computing Devices

FIG. 2 is a high-level block diagram illustrating physical components ofan example computer 200 that may be used as part of a client device 110,application server 130, and/or database server 140 from FIG. 1,according to one embodiment. Illustrated is a chipset 210 coupled to atleast one processor 205. Coupled to the chipset 210 is volatile memory215, a network adapter 220, an input/output (I/O) device(s) 225, astorage device 230 representing a non-volatile memory, and a display235. In one embodiment, the functionality of the chipset 210 is providedby a memory controller 211 and an I/O controller 212. In anotherembodiment, the memory 215 is coupled directly to the processor 205instead of the chipset 210. In some embodiments, memory 215 includeshigh-speed random access memory (RAM), such as DRAM, SRAM, DDR RAM orother random access solid state memory devices.

The storage device 230 is any non-transitory computer-readable storagemedium, such as a hard drive, compact disk read-only memory (CD-ROM),DVD, or a solid-state memory device. The memory 215 holds instructionsand data used by the processor 205. The I/O device 225 may be a touchinput surface (capacitive or otherwise), a mouse, track ball, or othertype of pointing device, a keyboard, or another form of input device.The display 235 displays images and other information from for thecomputer 200. The network adapter 220 couples the computer 200 to thenetwork 150.

As is known in the art, a computer 200 can have different and/or othercomponents than those shown in FIG. 2. In addition, the computer 200 canlack certain illustrated components. In one embodiment, a computer 200acting as server 140 may lack a dedicated I/O device 225, and/or display218. Moreover, the storage device 230 can be local and/or remote fromthe computer 200 (such as embodied within a storage area network (SAN)),and, in one embodiment, the storage device 230 is not a CD-ROM device ora DVD device.

Generally, the exact physical components used in a client device 110will vary in size, power requirements, and performance from those usedin the application server 130 and the database server 140. For example,client devices 110, which will often be home computers, tabletcomputers, laptop computers, or smart phones, will include relativelysmall storage capacities and processing power, but will include inputdevices and displays. These components are suitable for user input ofdata and receipt, display, and interaction with notifications providedby the application server 130. In contrast, the application server 130may include many physically separate, locally networked computers eachhaving a significant amount of processing power for carrying out theanalyses introduced above. In one embodiment, the processing power ofthe application server 130 provided by a service such as Amazon WebServices™. Also in contrast, the database server 140 may include many,physically separate computers each having a significant amount ofpersistent storage capacity for storing the data associated with theapplication server.

As is known in the art, the computer 200 is adapted to execute computerprogram modules for providing functionality described herein. A modulecan be implemented in hardware, firmware, and/or software. In oneembodiment, program modules are stored on the storage device 230, loadedinto the memory 215, and executed by the processor 205.

III. Dashboard

The dashboard, for example dashboard 300 illustrated in FIG. 3A, allowsusers to interact with the analytics system 100. The dashboard 300provides a means to transfer information on a user-to-user (e.g.,patient 111 to provider 112) or user-to-system/system-to-user basis.Dashboards 300 are accessed through the client application 115 on theclient device 110 and provide a mechanism for both patients andhealthcare providers to monitor medication rescue events, exchangepersonalized patient healthcare information, and received notifications.Patients may communicate with other health care provider and otherpatients through the dashboard 300, for example, to discuss and shareinformation about their condition, medication usage, and management. Theability to share healthcare information may give patients or healthcarecare providers experiencing a same issue a way to share individualperspectives.

The dashboard 300 also allows authorized health care providers 112 toaccess a list of patients to view, annotate, update, interact with, andexport information about patient and community data and statistics invarious demographics or geographic segments. Using the dashboard 300,healthcare providers are able to monitor patients individually or inaggregate, to receive and provide feedback (e.g. compliance reminders)on how their associated patient populations are responding to medicationand condition management guidance. A healthcare provider who has accessto individual or multiple patients has the ability to establishnotification thresholds, set parameters for the notifications, andreceive notifications when patients' event history matches certainconditions (e.g., a rescue event). Additionally, the dashboard 300 canreceive and display regular reports of event patterns for specificdemographic generated by the analytics system 100.

The dashboard 300 presents a variety of information including tabulardata, graphical visualizations, and analyses to users through display“cards” 310. Display cards 310 are conformably suited to smallerdisplays typical of portable client devices 110, for example mobilephones or tablets, and include “bite size” pieces of information thatmimic the simplistic organizational style found in baseball cards. Thedashboard 300 may also include a system menu 305 that allows users tonavigate through different categories of healthcare information.

Notifications provided by the application server 130 are related to thedisplay cards 310. Generally, notifications include not only informationto be presented to the user through the application 115, but alsoparameters for specifying which display card 310 is to be used todisplay the contents of the notification. Generally, any informationpushed/pulled from the application server 130 may be associated with oneor more cards. For example, a notification can be pushed to the patientbased on the outcome of an analysis performed by server 130. Thedashboard 300 will process the notification and determine which card/sto use to present the information in the notification. Continuing theexample, the recipient of the notification may make a request (pull)data from the application server 130. The application server 130provides the requested data in another notification, and the dashboard300 then determines which display card 310 to display the requestedinformation.

To interact with information presented, some display cards 310 a includea input response 315 area. For example, in the display card 310 billustrated in FIG. 3B, a patient may scroll up or down in the inputresponse 315 area to select a controller medication used to manage COPDor select the “next” to move to an additional display card 310.

The dashboard 300 may provide a variety of different display cards 310,which may be organized into categories. A single display card 310 mayfall into one or more categories. An information card type includesnon-actionable cards that merely display data. Information cards may,for example, medication usage events, statistics, and maps includingboth patient data and community data. Information cards are furthersub-categorized into event and trend display cards. Event cards includedata relating to controller and rescue medication events, such as a listof historical medication rescue events for a specific patient, orpatient rescue event data overlaid on a geographical map for a specificprovider. For example, the display card 310 a illustrated in FIG. 3B isan event card that highlights patients experiencing COPD rescue eventsin a particular geographic area.

A trend card include statistical information presented using a graph ora chart designed for clear comprehension by the recipient. Trend cardsmay include an analysis based on one or more types of information overone or more time periods. For example, trend cards may illustrate lineor bar charts that summarize medication usage over time periods. FIG. 3Eillustrates two different example trend cards, plotting COPD rescueevents 310 c and COPD controller medication adherence 310 d, both overvarious time periods. FIG. 3H illustrates a trend card 310 n that showsweek-over-week adherence data and trends. FIG. 3I illustrates fourdifferent example trend cards. Card 310 o displays a time of day trendindicating the proportion or amount of medication events that occurduring a particular time of day, card 310 p displays a symptom trendindicating the proportion or amount of a patient's symptoms that are aparticular symptom, card 310 q displays a day of week trend indicatingthe proportion or amount of medication events that occur during a day ofthe week, and card 310 r displays a trigger trend indicating theproportion or amount of a patient's medication events that are caused bya particular trigger. FIG. 3J illustrates two example trend cards. Card310 s and 310 t display days with symptoms in the prior seven days,nighttime events in the prior thirty days, and an asthma control scoreindicator (e.g., “Still Learning” and “Well Controlled”).

A survey card type solicits a user response by presenting yes/no,multiple choice, or more open-ended questions for the user to respondto. For example, a healthcare provider or the analytics system 100 maysend a survey card with a COPD questionnaire to a patient 111 todetermine a level of disease control for a specific patient. As anadditional example, a survey card may request the type of controllermedication that the patient 111 uses to treat COPD symptoms, as shown inthe display card 310 b illustrated in FIG. 3B. Generally, survey cardsprovide the application server 130 with data that may be missing from apatient's medical history or patient profile (as introduced above),and/or provide an update to possible outdated information. Generally,one or more survey cards may be used to complete the patient enrollmentprocess and create a patient profile for storage in database server 140.As a specific example, when a patient 111 initially enrolls in theanalytics system 100, a push notification will be triggered by theapplication server 130 prompting the patient 111 to create a patientprofile. Example of survey cards are illustrated in FIGS. 3F, 3G, and3K, which illustrate a survey question asking whether pollen is a COPDtrigger 310 e, what the patient's controller medication is 310 f, howmany times the patient used their rescue medication to control an event310 g, what their controller medication daily schedule is 310 h, and howoften asthma has kept the patient from getting things done in the lastfour weeks 310 u. Survey cards may also ask about a patients asthmatriggers. Other survey cards ask a patient to rate their general qualityof life on 5-point Likert scale, to rate their quality of sleep, to ratetheir ability to be active over last 7 days, and so on. Other surveycards ask whether the patient feels better or worse than yesterday,whether the patient has had to go to emergency room or hospital in last12 months for an exacerbation and so on.

In some instances, patient behavior or sensor-reported event informationthat is inconsistent with existing patient information may trigger thesending of a survey card in order to resolve ambiguity as to thepatient's circumstances. For example, if the patient is experiencing agreater-than-expected count of COPD events, the survey card may requestinformation about the type of medication the patient is currently usingas listed on their medicament device 160, in order to verify that thecorrect medication is being used. As another example, if the reportedinformation about controller medication use indicates that the patientis only using the controller medication one time per day but theiradherence plan indicates they are supposed to be taking their controllermedication twice per day, system 100 could send a notification asking ifthe patient needs to change their adherence plan. FIG. 3L illustrates anexample survey card 310 v for asking whether a patient wants the timezone associated with the patient's profile to be changed based ondetecting a different time zone associated with a client device 110. Thesurvey card 310 v includes an input response area 315 d that mayautomatically update the profile time zone or navigate to a differentscreen in the user interface for changing the profile time zone.

Navigation cards represent actionable data or messages that, upon userinteraction, may redirect the user to another screen or card that ispart of the dashboard 300. For example, if a patient wants to shareinformation or request specific medication plans for controllermedications with a physician, a navigation card would be used tofacilitate the sharing of information or enrollment in controlleradherence plan. Additionally, navigation cards allow users to updateinformation surrounding medication rescue events. For example, the cardof FIG. 3H includes input response area 315 c to view adherence details.Selecting button 350 redirects the user to the timeline illustrated inFIG. 3M, which is discussed in more detail below.

Adherence cards are designed to encourage a patient to continually usetheir controller medication on schedule over different periods of time.FIGS. 3C and 3H illustrate example adherence cards. Cards 310 i, 310 j,and 310 k are example adherence summary cards. The cards 310 i-killustrate a metric of adherence over a time period, such as proportionof doses a patient has taken over the last week. The cards 310 i-k mayalso compare the metric of adherence during prior time periods (e.g.,last week) to illustrate a trend in adherence. The cards may include agraphical indicator of the adherence metrics. In card 310 i, thepatient's weekly adherence is 70%, as shown by the darker line thatextends around 70% of the circular indicator 371. The patient'sadherence the prior week was 75% as indicated by the lighter line. Thesmaller indicator 375 shows a percent change between the previous timeperiod and the current time period. In card 310 j, the current week'sadherence is 75% while the previous week's is 70%, and in card 310 k,the current week and the previous week have the same adherence of 70%.Card 310 n displays week-over-week adherence data and trends. Additionalexample adherence cards are described below with respect to FIGS. 5A-Land 6A-I.

FIGS. 3D, 3M and 3N illustrates example user interfaces presented in thedashboard 300. FIG. 3D illustrates a list 370 of dose adherence detailsby week for a particular medication (“Spirriva”). The list entriesinclude a time period (e.g., “This week”), a summary of the proportionof doses taken (e.g., 75% of Spirriva doses taken), and a graphicalillustration of daily adherence. The checkmarks indicate that all doseswere taken for a particular day, while a number indicates that some butnot all doses were taken and a dash indicates no doses were taken. FIG.3M illustrates a list 320 of controller usage events 322 a-322 c. Thelist 320 may be presented to a recipient responsive to selection of the“View Adherence” input response area 315 c of FIG. 3H. Returning to FIG.3M, the list 320 displays controller usage events over a time period andincludes details such as date, time, number of puffs, and location.Recipients may edit rescue usage events and/or add additional detailssuch as experienced symptoms and suggested triggers by selecting theedit interaction response areas 324 a-d. FIG. 3N illustrates informationregarding an asthma control score indicator displayed, for example incards 310 s and 310 t of FIG. 3J.

IV. Event Detection Process

As an initial step for generating notifications, a patient interfaceswith the dashboard 300 to 405 a patient profile. Once the patient isfinished completing their patient profile, the client device 110transmits the patient profile for use by the application server 130 andstorage by the database server 140. Once a patient's patient profile isinitialized, the application server 130 may begin to receive medicationsevents, including rescue medication events and controller medicationevents detected by the sensor 120 associated with the patient'smedicament device 160.

Referring now to FIG. 4, the application server 130 generally receivesan event anytime the patient uses their rescue or control medicamentdispenser 160 to relieve difficulty breathing or other respiratorysymptoms. As an example of the process for capturing such an event for aparticular device 160/sensor 120 combination, at the start of symptoms,the sensor 120 may detect 405 whether a medication dispenser 160 coveris opened. When the medication dispenser cover is opened, the sensor 120may detect an acceleration 410 associated with a priming of thedispenser 160. For some types of medicament dispensers, the “priming”includes activating a mechanism to release a dose of a medication from apackaging. In other types of medicament dispensers, the “priming”includes a rapid shaking of a medication canister.

After the priming action is detected, the sensor 120 is configured tostore 415 data associated with the event in active memory of the sensor120. The event data may include information that describes the time anddate of associated with the event, the status or condition of themedicament device 160 (e.g. battery level), the number of doses ofmedication remaining (before or after the event), self-test results, andphysiological data of a patient being treated with the medicament device160 as measured by the sensor 120. As soon as the sensor establishes anetwork connection with either the client device 110 or network 150, thesensor transmits 425 any locally stored event data to the client device110 or the application server 130. If the event data was transmitted tothe client device 110 first, the client device 110 then transmits 430the event data to the application server 130 as soon as the clientdevice 110 establishes a network connection with the network 150.Depending upon the implementation, either the client device 110 orsensor 120 will add the geographic location where the event took placeto the event data transmitted to the application server 130.

V. Controller Medication Dosing Notifications

One type of analysis performed by the data analysis module 131 is toanalyze controller medication usage events (i.e., doses taken by thepatient) recorded by the application server 130 as reported by theclient device 110, sensor 120, and/or medicament device, in order toprovide notifications to the patient that both report historicalinformation about the events, and also to provide recommendations aboutwhether and when to take their next dose. These recommendations are alsodetermined based on the controller medication plan set up by the patient111 or their healthcare provider 112.

V.A. First Embodiment

FIG. 5A illustrates an example timeline of a first embodiment fordetermining whether to recommend that the patient take their next dose,as may be included in a notification sent to the patient's device 110.In the first embodiment, a multi-hour hour “narrow” window around apatient's planned dose (e.g., two hour window, one hour before plan timeand one hour after plan time) is used to evaluate whether to recommendthat the patient take a dose of controller medication. If a patienttakes a dose after their plan time, but inside the narrow window, thenthe data analysis module 131 will still remind the patient to take thenext dose. For example, if the patient's plan time is 9 am, and theytake the dose at 9:59, then the data analysis module 131 will stillremind them to take the next dose (9 pm).

Alternatively, if the patient takes a dose outside of the narrow window,the data analysis module 131 will not remind the patient to take thenext dose. For example, if the patient's plan time is 9 am, and theytake the dose at 10:01, then the data analysis module 131 will notremind them to take the next dose (9 pm). If the patient's plan time is9 am, and they take the dose at 12 pm, then the data analysis module 131will not them to take the next dose, etc.

This is a coarse solution. Historical data estimates about 40% ofcurrent usages may fall outside of the narrow window around planned dosetime. Consequently, this implementation will stop reminding patients totake the next dose in up to 40% of cases. However, a benefit of thissolution is that it is very conservative. Reminding a patient to take adose they should not take can pose a problem for patient safety issue.This solution biases against reminding a patient to do something thatcould lead to a them taking an overdose and experiencing an adverseevent.

FIG. 5B illustrates an example of the timeline of the first embodimentfor a dosing plan that specifies that a dose is to be taken four times aday. In this example, a first dose is taken at 8 am and is registered bymodule 131 as on time. Another dose is taken at 8:30 am and isregistered as an excess dose as it was taken too close in time to theprevious dose. Another dose is taken at 10:15 which is also too early intime to be registered as the 2 pm dose, and thus is also registered asan excess dose.

Assume for sake of example that the software application associated withthe server 130 was viewed by the patient 111 on their client device 110.In this instance, the module 131 may provide a notification thatprovides a recommendation as to whether the patient 111 should taketheir 2 pm dose. In this case, due to either or both of the two priorexcess doses that occurred after the on time dose, the module 131recommends that the patient skip their 2 pm dose. Alternatively, at somepoint prior to their 2 pm dose, for example one hour before, the module131 may push a notification to the client device 110 with the sameinformation.

FIGS. 5C-5G illustrate additional examples of timelines of the firstembodiment for a dosing plan that specifies that a dose is to be takentwice a day. In FIGS. 5C and 5D, only a single dose is registered withina 1 hour narrow window, and thus both are registered as on time doses.In FIG. 5E, a first dose is taken within the 1 hour narrow window, andis initially registered as an on time dose. However, when another doseis closer to on time, in this case right at 9 am, the second dose isregistered as the on time dose, and the prior dose is re-categorized asan excess dose as it was taken further in time from the planned dosingtime.

In FIG. 5F, a first dose is taken within the 1 hour narrow window and isregistered as an on time dose. Another dose taken later within thenarrow window and also not sufficiently close in time is registered asan excess dose. In this case, since neither the first nor the seconddose was on time or close to on time, the first registered dose is giventhe designation of on time. Another dose taken at 10:30 am is registeredas excessive. Yet another dose is initially registered as excessive at 5pm. At some point in time before the planned 9 pm dosing, or in responseto the patient 111 checking the software application associated with theserver 130, the module 131 provides a notification indicating that thepatient 111 should skip the 9 pm dose due to any one or more of thepreviously registered excess doses. If the patient 111 follows theinstructions then the 5 pm excess dose is re-categorized as merely beinga not on time dose, as this dose now represents the dose that issubstituting for a more on-time dose that hypothetically could have beentaken closer to the planned 9 pm dose time. However, as illustrated byFIG. 5G, if the patient 111 does not view or ignores the notificationprovided by module 131 and instead chooses to take a dose closer to theplanned 9 pm dose time, such as at 7:30 pm, then the 5 pm dose remainsregistered as an excess dose and the 7:30 pm dose is registered as a notone time dose, representing that it is the dose that is the bestsubstitute for the planned 9 pm dose.

Generally, these examples represent that the categorization of a dose isnot fixed in time or upon registration, but instead that categorizationsshift based on subsequent controller medication events reported to theserver 130.

The lengths, times, and relative positions of the time windows describedin FIGS. 5A-5G are shown as examples for illustration. In practice, thetime windows, dose characterization and other characteristics of theexamples above can be adjusted to apply to different adherence scheduleswith different dose times, dose frequency, and time windows based ondrug characteristics, provider input, and other considerations.

FIGS. 5H-5L illustrate example display cards 310 that may be presentedas part of notifications in accordance with this first embodiment. Inthe example of FIG. 5H, a separate listing is illustrated for eachdosing planned for that day, in this case two separate dosings ofAzmacort. Color coded graphics indicate whether a dose was taken that isregistered for that planned dosing and what time it was taken (8:05 AM),whether it was on time (using e.g., color or pattern), whether it isstill planned to be taken in the future based on the time of viewing ofthe notification (“Next” in circle), and when the last time the clientdevice 110, sensor 120, and/or medicament device 160 synched with theserver 130 to establish whether the information presented in thenotification is current for the user (“Sensor Last Synced: 11:18 AM”).The example of FIG. 5H indicates that the dose scheduled for 8:00 AM wastaken on time at 8:05 AM, and the next dose is scheduled for 8:00 PM.

In the example of FIG. 5I, the colors correspond to the dose status,meaning whether the a dose was on time (good), off schedule (ok), orexcessive (bad). In another embodiment, the dose status is indicated bydifferent patterns, shapes, or other methods. Similarly to FIG. 5H, theplanned dosing are each illustrated. Excessive dosings may beillustrated as separate graphical icons in addition to the planneddosings, along with when they were taken.

The example display card of FIG. 5J is similar to the card of FIG. 5H,however, the medication is different (Advair Diskus) and the 11:AM dosewas taken late at 1:00 PM, as indicated by the color. The exampledisplay card of FIG. 5K illustrates a missed dose at 11:00 AM. Theexample display card of FIG. 5L illustrates a situation in which thesensor has not been synced after the scheduled time of the last dose. Inthe example of FIG. 5L, there is a first missed dose at 9:00 AM and anunknown status of the second dose at 9:00 PM.

V.B. Second Embodiment

FIG. 6A illustrates an example timeline of a second embodiment fordetermining whether to recommend that the patient take their next dose,as may be included in a notification sent to the patient's device 110.In a second embodiment, an expanded window around planned dose time isalso used to determine whether to recommend that the patient take theirnext dose of controller medication, and categorize and log each previousdose event. This expanded window may be used alone, or in combinationwith the narrow window from the first embodiment described in the priorsection. This expanded window will be based on the dosing schedule ofthe controller medication (e.g., one dose per day, two dose per day,etc.). The dosing schedule of a drug is based on the pharmacokinetic(PK) profile of the drug, which can be illustrated as a curve, and whichrepresents the concentration of the drug in blood as a function of time,which thereby provides information about how quickly it is eliminatedfrom the body. Typically one dose per day drugs have longer curves,meaning that they stay in body longer, so you only need to dose once perday. Drugs that have to be dosed more frequently (two doses a day, fourdoses a day, etc.) have shorter curves, meaning that they are eliminatedmore quickly from the body.

Several categories are defined for usage events corresponding to priordoses. If a time associated with the usage event indicates that thepatient took a prior dose within the narrow window defined in theprevious embodiment, then that dose is registered as an on scheduledose, under the assumption that it was taken close in time to theplanned dosing time. Generally, an on-schedule prior dose willcontribute to the data analysis module 131 generating a notificationthat recommends that the patient should in fact take their next dose.

If a time associated with the usage event indicates that the prior dosewas taken outside the narrow window but within the expanded window, thenthe dose is registered as an off schedule dose (or more specifically asa first type of off schedule dose), under the assumption that it was nottaken at an ideal time from a pharmacokinetic standpoint, butsufficiently close in time to the planned dosing time to be effective.Generally, an off-schedule dose of this type will also contribute to thedata analysis module 131 generating a notification that recommends thatthe patient should in fact take their next dose.

If the prior dose was taken outside both the narrow and expanded window,then the dose is registered as an off schedule dose (or morespecifically as a second type of off schedule dose. Generally, anoff-schedule dose of this type will contribute to the data analysismodule 131 generating a notification that recommends that the patientshould not take their next dose, under the assumption that the priordose was too close in time to the prior dose. This helps the dataanalysis module 131 avoid recommending additional doses that mighttrigger an overdose event.

FIG. 6B illustrates a first example of the timeline of the secondembodiment for a dosing plan that specifies that a dose is to be takentwo times a day. In this example, a six hour expanded window, threehours before or after the planned dosing time, may be assigned aroundthe dosing time. Additionally, a two hour narrow window, one hour beforeor after the planned dosing time, may also be assigned around the dosingtime. More specifically, if the planned dosing times are 9 am and 9 pm,the narrow windows may be 8 am to 10 am and 8 pm to 10 pm, and theexpanded windows may be 6 am to 12 pm and 6 pm-12 am.

The size of the expanded window may vary depending upon the dosingschedule of controller medication. In one embodiment, the greater thenumber of doses per day, the shorter in time the expanded window is. Forexample, a single dose per day controller medication may have anexpanded window that is twelve hours in time, six hours before or afterthe planned dosing time. A three dose per day controller medication mayhave a four hour expanded window, two hours before or after each planneddosing time. A four dose per day controller medication may have a threehour expanded window, one and a half hours before and after each planneddosing time.

Using the two dose per day example of FIG. 6B, if the patient takes adose at 8:30 am and another dose at 9:30 am, the first dose will beregistered as an on time dose as is was within the narrow window, andthe second dose will be registered as an excessive dose. Another dosetaken at 5 pm will be registered as an excessive dose if another dose istaken in closer proximity to the scheduled 9 pm dosing time (not shown),and as an off-schedule dose if no other dose is taken in proximity tothe scheduled 9 pm dosing time. If the software application supportingserver 130 is viewed on the client device 110, for example at 5 pm, orif a notification is pushed to the client 110 device in advance of the 9pm dosing time, then the user will be recommended to skip the 9 pm dosedue to the prior excessive doses at 5 pm and 9:30 am.

As additional examples (not shown in the figures), again using the twoplanned dose per day example, if the patient takes a first dose at 9 amand another dose at 11:59 am, the data analysis module 131 will stillremind patient of 9 pm dose. The data analysis module 131 registers thefirst of these doses as a good dose, and the second of these doses as anexcessive dose, as over the period of the entire day, the patient willend up taking two or more doses rather than the planned exactly twodoses. If the patient misses the dose at 9 am and takes a dose at 11:59am, the data analysis module 131 will still remind the patient of 9 pmdose. The data analysis module 131 registers this single dose as anoff-schedule dose, as according to the plan, If the patient takes a doseat 9 am and another dose at 12:01 pm, then the data analysis module 131does not remind the patient of 9 pm dose. The data analysis module 131registers the first dose as a good dose, and the second dose as an offschedule dose. If the patient misses their dose at 9 am and takes a doseat 12:01 pm, then the data analysis module 131 does not remind patientof 9 pm dose. The data analysis module 131 registers the first doses asa missed dose, and the second of these doses as an off-schedule dose.

FIGS. 6C-6G illustrate additional examples of timelines of the secondembodiment for a dosing plan that specifies that a dose is to be takentwice a day. In FIGS. 6C and 6D, only a single dose is registered withina 1 hour narrow window, and thus both are registered as on time doses.In FIG. 6E, a first dose is taken within the narrow window, and isinitially registered as an on time dose. However, when another dose iscloser to on time, in this case right at 9 am, the second dose isregistered as the on time dose, and the prior dose is re-categorized asan excess dose as it was taken further in time from the planned dosingtime.

In FIG. 6F, a first dose is taken within the 1 hour narrow window and isregistered as an on time dose. Another dose taken later within thenarrow window and also not sufficiently close in time is registered asan excess dose. In this case, since neither the first nor the seconddose was on time or close to on time, the first registered dose is giventhe designation of on time. Another dose taken at 10:30 am is registeredas excessive. Yet another dose is initially registered as excessive at 5pm. At some point in time before the planned 9 pm dosing, or in responseto the patient 111 checking the software application associated with theserver 130, the module 131 provides a notification indicating that thepatient 111 should skip the 9 pm dose due to any one or more of thepreviously registered excess doses. If the patient 111 follows theinstructions then the 5 pm excess dose is re-categorized as merely beinga not on time dose, as this dose now represents the dose that issubstituting for a more on-time dose that hypothetically could have beentaken closer to the planned 9 pm dose time. However, as illustrated byFIG. 6G, if the patient 111 does not view or ignores the notificationprovided by module 131 and instead chooses to take a dose closer to theplanned 9 pm dose time, such as at 7:30 pm, then the 5 pm dose remainsregistered as an excess dose and the 7:30 pm dose is registered as a notone time dose, representing that it is the dose that is the bestsubstitute for the planned 9 pm dose.

The lengths, times, and relative positions of the time windows describedin FIGS. 6A-6G are shown as examples for illustration. In practice, thetime windows, dose characterization and other characteristics of theexamples above can be adjusted to apply to different adherence scheduleswith different dose times, dose frequency, and time windows based ondrug characteristics, provider input, and other considerations.

FIGS. 6H and 6I illustrate example display cards 310 that are similar tothe example display cards of FIGS. 5H and 5I.

Other types of display cards 310 may also be presented that includeinformation gathered about events related to controller medicationdoses. For example, the card 310 n of FIG. 3H may display the controllermedication adherence percentage for a given week. In the instance wheredata has only begun being collected or after a prolonged gap in datareported to the server 130, from day 2 up until day 7 a partial week'sdata will be displayed as the current week's adherence percentage, andfrom day 7 up until day 14 the previous 7 day's adherence percentage(rolling 7 days) will be displayed as the current week's adherencepercentage. After day 14 of continuously collected data, the previous 7day's adherence percentage (rolling 7 days) will be displayed, comparedto the adherence percentage of the rolling 7 day period that precedesit.

V.C. Missed Doses and Reminders

Although the examples illustrated with respect to the first and secondembodiments above are all related to recommendations about whether totake an upcoming dose, it is contemplated that there will also bescenarios where the patient does not take a scheduled dose, either ontime, within the narrow window, within the extended window, or even inbetween those windows on either side of two adjacent planned dose times.In these instances, the module 131 will generate a notification to beeither pushed to the client device 110 or shown next time the softwareapplication supporting server 130 is viewed by the patient 111. Thisnotification may include a display card 310 (not explicitly shown)either reminding the patient to take a dose and/or reminding them totake a dose within one of the windows of the next planned dose.

It is further possible that the patient did in fact take the dose, butfor device or connectivity issues the taking of the dose was notregistered by one of the physical devices configured to report or relaythe controller medication event to the server 130. For example, if themedicament device 160 or the sensor 120 had some form of mechanical,electrical, or digital error, or if one of the sensor 120 or clientdevice 110 could not communicate with the server 130, for example due towireless service (e.g., 802.11) or BLUETOOTH service being interrupted,an event may not be reported.

Although service 130 may receive some information about what kind oferror is occurring (e.g., a dedicated hardware hub for sensor 120 isuninstalled, or the supporting software application on client device 110has been deactivated or uninstalled), regardless of the type of errorthe server 130 experiences the error as a lack of event data that willaffect its ability to provide useful recommendations regardingcontroller medication dosing.

To address this issue, the server 130 is configured to sendnotifications to the client device 110 and/or the patient's and/orhealthcare providers email and SMS accounts that request status from thepatient 111. These notifications encourage them to reactivate or connectany involved computing hardware (e.g., the sensor 120, client device110) or software (the supporting software application), as well as enterany controller medication events that may have occurred in theintervening period. The notifications may include information about thegap of time that has occurred to provide the patient 111 with a windowfor which to provide data.

The timing and form of these notifications may vary, both based on typeof error (e.g., knowing that BLUETOOTH is off vs. not knowing why noevent data has been received), and also based on the amount of timesince an event or any other kind of data has been reported from thesoftware application 115, device 110, sensor 120, or medicament device160. In one embodiment, over a month period more notifications ofincreasing variety (e.g., display card, email, SMS, personal phone call)are transmitted as the duration since the last reported data increases.For example, separate reminders about the error or lack of data may besent at days 2, 4, 7, 14, 17, 21, 24, and 28 since last reporting.

In one embodiment, the notification is a card 310 such as the card ofFIG. 5L that includes the time of the last synchronization. If theuser's last dose time is after the last sensor sync event, the card 310will show that the sensor 120 and the client 110 need to synchronizebefore the server 130 can determine if the last dose was on or offschedule.

VI. Additional Considerations

It is to be understood that the figures and descriptions of the presentdisclosure have been simplified to illustrate elements that are relevantfor a clear understanding of the present disclosure, while eliminating,for the purpose of clarity, many other elements found in a typicalsystem. Those of ordinary skill in the art may recognize that otherelements and/or steps are desirable and/or required in implementing thepresent disclosure. However, because such elements and steps are wellknown in the art, and because they do not facilitate a betterunderstanding of the present disclosure, a discussion of such elementsand steps is not provided herein. The disclosure herein is directed toall such variations and modifications to such elements and methods knownto those skilled in the art.

Some portions of above description describe the embodiments in terms ofalgorithms and symbolic representations of operations on information.These algorithmic descriptions and representations are commonly used bythose skilled in the data processing arts to convey the substance oftheir work effectively to others skilled in the art. These operations,while described functionally, computationally, or logically, areunderstood to be implemented by computer programs or equivalentelectrical circuits, microcode, or the like. Furthermore, it has alsoproven convenient at times, to refer to these arrangements of operationsas modules, without loss of generality. The described operations andtheir associated modules may be embodied in software, firmware,hardware, or any combinations thereof.

As used herein any reference to “one embodiment” or “an embodiment”means that a particular element, feature, structure, or characteristicdescribed in connection with the embodiment is included in at least oneembodiment. The appearances of the phrase “in one embodiment” in variousplaces in the specification are not necessarily all referring to thesame embodiment.

As used herein, the terms “comprises,” “comprising,” “includes,”“including,” “has,” “having” or any other variation thereof, areintended to cover a non-exclusive inclusion. For example, a process,method, article, or apparatus that comprises a list of elements is notnecessarily limited to only those elements but may include otherelements not expressly listed or inherent to such process, method,article, or apparatus. Further, unless expressly stated to the contrary,“or” refers to an inclusive or and not to an exclusive or. For example,a condition A or B is satisfied by any one of the following: A is true(or present) and B is false (or not present), A is false (or notpresent) and B is true (or present), and both A and B are true (orpresent).

In addition, use of the “a” or “an” are employed to describe elementsand components of the embodiments herein. This is done merely forconvenience and to give a general sense of the invention. Thisdescription should be read to include one or at least one and thesingular also includes the plural unless it is obvious that it is meantotherwise.

While particular embodiments and applications have been illustrated anddescribed, it is to be understood that the disclosed embodiments are notlimited to the precise construction and components disclosed herein.Various modifications, changes and variations, which will be apparent tothose skilled in the art, may be made in the arrangement, operation anddetails of the method and apparatus disclosed herein without departingfrom the spirit and scope of this description.

1. (canceled)
 2. A method comprising: receiving a first medication usageevent by a medicament device recorded at a first recorded time and asecond medication usage event by the medicament device recorded at asecond recorded time, the second recorded time subsequent to the firstrecorded time; determining whether the first recorded time is within atime window inclusive of a scheduled time for a planned dose specifiedin a controller medication dosage plan; determining whether the secondrecorded time is within the time window; in response to determining thatthe first recorded time and the second recorded time are within the timewindow: characterizing one of the first medication usage event and thesecond medication usage event as an excessive dose; generating anotification indicative of the characterization of one of the firstmedication usage event and the second medication usage event as theexcessive dose; and presenting the notification on a display of acomputing device associated with the medicament device.
 3. The method ofclaim 2, wherein the scheduled time is in a middle of the time window.4. The method of claim 2, wherein the notification recommends a patientof the medicament device to skip a subsequent planned dose in thecontroller medication dosing plan.
 5. The method of claim 4, wherein thenotification provides an opportunity for a patient of the medicamentdevice to update the controller medication dosing plan.
 6. The method ofclaim 2, wherein a sensor is coupled to the medicament device andconfigured to detect a priming action of the medicament device, whereinthe sensor recorded the first medication usage event responsive tohaving detected a first priming action of the medicament device at thefirst recorded time and the second medication usage event responsive tohaving detected a second priming action of the medicament device at thesecond recorded time.
 7. The method of claim 6, wherein the firstpriming action and the second priming action include activating amechanism to release a dose of a medication from a packaging.
 8. Themethod of claim 6, wherein the first priming action and the secondpriming action include shaking of a medication canister loaded into themedicament device.
 9. The method of claim 2, wherein characterizing oneof the first medication usage event and the second medication usageevent as the excessive dose comprises: determining whether the firstrecorded time or the second recorded time is closer to the scheduledtime; in response to determining that the first recorded time is closerto the scheduled time, characterizing the second medication usage eventas the excessive dose and the first medication usage event as an on-timedose; and in response to determining that the second recorded time iscloser to the scheduled time, characterizing the first medication usageevent as the excessive dose and the second medication usage event as anon-time dose.
 10. The method of claim 2, further comprising: in responseto determining that one of the first recorded time and the secondrecorded time is within the time window and the other of the firstrecorded time and the second recorded time is not within the timewindow, characterizing the one within the time window as an on-time doseand the other not within the time window as an excessive dose.
 11. Themethod of claim 2, further comprising: in response to determining thatthe first recorded time and the second recorded time are not within thetime window, determining whether the first recorded time or the secondrecorded time is closer to the scheduled time; in response todetermining that the first recorded time is closer to the scheduledtime, characterizing the first medication usage event as an off-scheduledose and the second medication usage event as an excessive dose; and inresponse to determining that the second recorded time is closer to thescheduled time, characterizing the first event as an excessive dose andthe second event as an off-schedule dose.
 12. A non-transitorycomputer-readable storage medium storing instructions that, whenexecuted by a processor, cause the processor to perform operationscomprising: receiving a first medication usage event by a medicamentdevice recorded at a first recorded time and a second medication usageevent by the medicament device recorded at a second recorded time, thesecond recorded time subsequent to the first recorded time; determiningwhether the first recorded time is within a time window inclusive of ascheduled time for a planned dose specified in a controller medicationdosage plan; determining whether the second recorded time is within thetime window; in response to determining that the first recorded time andthe second recorded time are within the time window: characterizing oneof the first medication usage event and the second medication usageevent as an excessive dose; generating a notification indicative of thecharacterization of one of the first medication usage event and thesecond medication usage event as the excessive dose; and presenting thenotification on a display of a computing device associated with themedicament device.
 13. The storage medium of claim 12, wherein thenotification recommends a patient of the medicament device to skip asubsequent planned dose in the controller medication dosing plan. 14.The storage medium of claim 13, wherein the notification provides anopportunity for a patient of the medicament device to update thecontroller medication dosing plan.
 15. The storage medium of claim 12,wherein a sensor is coupled to the medicament device and configured todetect a priming action of the medicament device, wherein the sensorrecorded the first medication usage event responsive to having detecteda first priming action of the medicament device at the first recordedtime and the second medication usage event responsive to having detecteda second priming action of the medicament device at the second recordedtime.
 16. The storage medium of claim 12, wherein characterizing one ofthe first medication usage event and the second medication usage eventas the excessive dose comprises: determining whether the first recordedtime or the second recorded time is closer to the scheduled time; inresponse to determining that the first recorded time is closer to thescheduled time, characterizing the second medication usage event as theexcessive dose and the first medication usage event as an on-time dose;and in response to determining that the second recorded time is closerto the scheduled time, characterizing the first medication usage eventas the excessive dose and the second medication usage event as anon-time dose.
 17. The storage medium of claim 12, the operations furthercomprising: in response to determining that one of the first recordedtime and the second recorded time is within the time window and theother of the first recorded time and the second recorded time is notwithin the time window, characterizing the one within the time window asan on-time dose and the other not within the time window as an excessivedose.
 18. The storage medium of claim 12, the operations furthercomprising: in response to determining that the first recorded time andthe second recorded time are not within the time window, determiningwhether the first recorded time or the second recorded time is closer tothe scheduled time; in response to determining that the first recordedtime is closer to the scheduled time, characterizing the firstmedication usage event as an off-schedule dose and the second medicationusage event as an excessive dose; and in response to determining thatthe second recorded time is closer to the scheduled time, characterizingthe first event as an excessive dose and the second event as anoff-schedule dose.
 19. A system comprising: a medicament device sensorattached to a medicament device communicatively coupled to a computingdevice, the medicament device sensor comprising: one or more sensorsconfigured to detect usage of the medicament device as one or moremedication usage events; and a network adapter configured to communicatewith the computing device; and a computer-readable storage mediumstoring instructions that, when executed by a processor of the computingdevice, cause the processor to perform operations comprising: receiving,from the medicament device sensor, a first medication usage event by themedicament device recorded at a first recorded time and a secondmedication usage event by the medicament device recorded at a secondrecorded time, the second recorded time subsequent to the first recordedtime; determining whether the first recorded time is within a timewindow inclusive of a scheduled time for a planned dose specified in acontroller medication dosage plan; determining whether the secondrecorded time is within the time window; in response to determining thatthe first recorded time and the second recorded time are within the timewindow: characterizing one of the first medication usage event and thesecond medication usage event as an excessive dose; generating anotification indicative of the characterization of one of the firstmedication usage event and the second medication usage event as theexcessive dose; and presenting the notification on a display of a clientdevice associated with the medicament device.
 20. The system of claim19, wherein the notification recommends a patient of the medicamentdevice to skip a subsequent planned dose in the controller medicationdosing plan.
 21. The system of claim 20, wherein the notificationprovides an opportunity for a patient of the medicament device to updatethe controller medication dosing plan.